Cooperative Helps Wheeling Handle Employees Compensation, Legal responsibility Insurance coverage Claims

Wheeling Village Hall, 2 Community Blvd.

The village of Wheeling has seen a reduction in damage and liability insurance claims.

“Due to the good claims experience and the COVID-19 pandemic, we had fewer claims than expected and we needed fewer hours for security advisors,” said Michael Kaplan, the village’s finance director.

The news came as an update related to the July 16 meeting of the Municipal Claims and Safety Agreement (MCSA), a brief meeting in less than 15 minutes that was shared through Zoom with Kaplan, Michael Nugent of the MCSA program, Michael McGreal, the Wheeling Fire Chief, and Steve Burgess, Chairman of the Metro Risk Management Agency (which consists of park districts).

Nugent is the Wheeling Village Risk Management Advisor. He helped set up the MCSA group and does the administrative work for the village, Kaplan said.

“We pay him an annual fee for this work, but it’s a relatively small fee as it doesn’t take much time.

“It’s definitely not a full-time job.”

This is one of the benefits of using a cooperative to save full-time employees time and money.

The aim of the meeting this summer was to determine a true-up or the amount of money that a participant must pledge under the cooperative. Depending on the volume, credits or payments are issued.

“The cooperative is doing the village good service because we as a group can hire an employee compensation officer who only processes members’ claims and has a lower number of cases than a conventional (TPA) third-party administrator,” said Kaplan.

Kaplan said the village has self-insured its workers’ compensation and liability insurance claims since 2000, and has taken out an excess for major damage.

Prior to 2013, the village had a contract with a TPA responsible for managing workers’ compensation claims by working with the plaintiff, lawyers, doctors and others.

“The TPA model is very common with self-insurance companies and is a cost-effective solution for claims management,” said Kaplan.

The TPA model has “disadvantages”, said Kaplan, “above all the claims volume managed by individual claims adjusters”.

Claims adjusters who work for a TPA usually have more than 200 claims that they have to manage at a given point in time.

“With a case number of this size, they cannot take much care of a single claim, which means that injured employees are unable to work for longer than necessary,” said Kaplan.

“That means lost working time for the village, additional overtime costs and generally higher claims expenditure than would otherwise be the case.”

To address the issues associated with the TPA model, the village helped create the intergovernmental pool of organizations “that will collectively hire a claims adjuster to manage the claims of the participating organizations,” Kaplan said.

Affiliates hire a workers’ compensation claims adjuster who works exclusively for the pool, only manages the claims of its members, and is physically located in one of the member’s buildings.

While the Adjuster works solely for the members of the pool, he is an employee of a third-party company who oversees and pays the specialist, Kaplan said.

Since the appraiser only handles members’ claims and has a smaller number of cases, the specialist can “truly manage every work injury claim from start to finish, including weekly contact with injured employees who remain unemployed,” Kaplan said.

The adjuster is also the contact person for the timely return to everyday work.

“Cost savings result from the fact that employees can return to work more quickly after injuries in the workplace and process costs are reduced through better contact with injured employees,” said Kaplan.

Adjusters can work more closely with injured workers to ensure they get the medical treatment they need, that doctor appointments and tests are done on time, and that the worker can get back to work as soon as possible, he said.

A bonus of the agreement is the opportunity to learn to improve occupational safety and to conduct safety training after investigating claims.

“The program benefited the village through better claims management,” said Kaplan.

The group will meet again on November 19th for the time being.

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